#SkinSchool: Body acne causes and treatments

Bacne? Here’s what to do about breakouts on your back and chest, or anywhere else really.

Harper's Bazaar India

Whether you're susceptible to acne, or have been able to swerve spots for most of your life, none of us are immune to body breakouts. Indeed, regardless of facial blemishes, your chest, back, and even bottom can experience flare-ups—and one of the biggest triggers is your own perspiration. Sounds unpleasant, we know, but with the weather warming up it's natural to perspire more, though that alone isn't the culprit of body acne. With many of us working out and working at home, it's easy to dive into emails before finding a slot to rinse off. In fact, a recent survey found that 73 per cent of people don’t shower straight after working out. If this is done regularly then your skin can suffer.

“Your back and chest, like your face, has sebaceous glands that secrete sebum, which can combine with dead skin cells, bacteria, dirt, and sweat to block the hair follicles and create inflamed pores, leading to acne,” explains Dr Tiina Meder, dermatologist and founder of Meder Beauty Science. So, the longer you postpone your shower, the more chance bacteria has to brew as you’re simply not getting rid of those sweaty emissions.

Keeping your gym kit on is another no-no and can exacerbate the problem. “Tight, moisture-wicking materials generally aren’t breathable and can trap oil and dead skin for hours and hours, creating the perfect storm for a body breakout,” continues Meder. However, it’s not just the festering that can spur on spots, it’s the friction, too. “Our pilo-sebaceous unit (the base of a pore) doesn’t like to be agitated and its defence mechanism is to swell,” says Pamela Marshall, clinical aesthetician and owner of the Mortar and Milk clinic. This inflammation from constant rubbing around the hair follicles is what causes lumps and bumps on your bottom, aka ‘buttne’ (or folliculitis if you prefer the professional term). It doesn’t stop there. “If the folliculitis gets out of control and the infection becomes deeper then it’s known as carbuncles, which is a cluster of boils that feel like painful knots of pus under the skin—a bit like an acne cyst,” reveals Meder. If that hasn’t got you sprinting for the shower, we don’t know what will.

For those that do turn on the taps within minutes of finishing their cool down, know that another red flag is wearing your workout kit multiple times. The same survey cited earlier also showed that 31 per cent of people will often go up to four sessions before they resign their gym kit to the laundry basket. In reality, even just a 20-minute HIIT session warrants a wash cycle as all that bacteria and sweat you excreted will still be there when you pull it on the next time, leaving you more vulnerable to breakouts. In a pinch? Change your clothes but refresh the skin with Mario Badescu's AHA Botanical Body Wash. Acting like a disinfectant for skin, it protects against infection and helps treat conditions like acne. 

Other causes of 'bacne' and body breakouts
While sweat from exercise is a huge trigger, it isn’t the only one. Research shows that there is a link between stress and acne flare-ups, especially on your back, while the hormones that cause facial breakouts also play a part. “Too much androgen—the male sex hormone—is often the case in both male and females,” explains Marshall. “For women, whether we are about to start our menstrual cycle, pregnant or nursing, or have PCOS, we will experience shifts in our hormones. When oestrogen is dipping it means androgen is in abundance and can send messages to our sebaceous glands to produce more oil.” Once your pores are blocked with oil the bacteria can get to work on the skin surface causing inflammation and spots.

Other lifestyle aspects should also be examined. Just like workout gear can aggravate the issue, so too can dirty bedsheets, so wash them weekly to see if that makes a difference. How you wash yourself is something else to consider. “Another very common reason for body acne is due to hair conditioner as it’s formulated to adhere to the hair follicle—so often for people with this type of acne, we just change the way they shower so the body gets washed after all the hair conditioner is rinsed out,” she says.

Talking of body hair, it’s important to clean in the direction of the hair grain, according to consultant dermatologist, Charlie Mitchell—that means smoothing your shower products down your legs and arms and not up and down repeatedly, as this can irritate the follicles by forcing them the wrong way. For hair-free areas, circular motions with gentle pressure is best, he says. And don’t over-wash. “Regular cleansing is always useful but too much washing can have a detrimental effect by stripping away too much of the natural sebum that our skin uses as a defence against the outside world,” he says.

Are products a problem?
Products that block the pores can worsen the breakouts and spur on inflammation but often they’re not the sole cause. If you do want to be diligent with what you’re using then it’s important to avoid ingredients that are potentially comedogenic (pore-blocking). “This includes oils, silicone, fragrance, lanolin, petrochemicals (for example paraffin, wax, mineral oil or petrolatum) and sodium chloride. You wouldn’t think salt would be used in formulations but it’s sometimes used as a thickening agent, especially in body make-up,” explains Dr Charlene DeHaven, Clinical Director of iS Clinical.

“Product-wise, the repeat offenders are likely to be fragranced body lotions and oils, and mineral SPFs that don’t contain micronised formulations of zinc and titanium dioxide. Take care with body make-up, too, which is growing in popularity as we seek to contour limbs. Choose water-based formulas where possible and avoid ingredients like bismuth oxychloride (which gives powders their shimmery finish but has been linked to cystic acne) and mica, silica, and talc which can be found in bronzers and can irritate already inflamed skin,” she continues. Something to consider if you like to use products on your décolletage but are prone to spots in that area, too.

How to beat body acne and breakouts: skincare and professional treatments
Dr Ginni Mansberg, GP, skin expert and founder of ESK Skincare says that if body acne becomes severe you should try and see a dermatologist, “to leap straight to the more intense treatments to prevent scarring”. For milder cases of bacne—and breakouts on the chest or bottom—topical skincare should be the first port of call.

“All acne, mild or severe, will benefit from vitamin A which is now considered the mainstay of treatment of acne,” says Dr Mansberg. “Of the over-the-counter retinoids, retinal is the most effective and the least irritating form of vitamin A.”

Alpha hydroxy acids
Otherwise known as AHAs, “these break down some of the bonds between skin cells helping older skin cells shed or exfoliate”. That’s why they tend to be used in higher concentrations as ‘skin peels’, but they are also effective when used at lower doses on a daily basis, Dr Mansberg offers.

Salicylic acid
“We have tons of evidence that salicylic acid [a BHA] can help acne-prone skin. That’s because salicylic acid is anti-inflammatory, helps with skin cell turnover, and has some activity against the bacteria known to cause acne.”

She adds that you can get salicylic acid in over-the-counter products (here are some of the best salicylic acid-based cleansers, toners and serums) ranging between 0.5 and 5 per cent concentration for use once or twice a day, as well as up to 30 per cent concentration in prescription products or peels used in clinics. For home use, “you can try a topical salicylic acid leave-on mask, such as the Hydroxy Overnight Mask to spot treat pimples or once a week for acne prone skin”. You’ll also find the ingredient in incorporated into dissolving microneedle patches “designed to help minimise developing pimples and prevent acne scarring”.

Vitamin B3, aka niacinamide
“Niacinamide is anti-inflammatory and antibacterial,” Dr Mansberg confirms, “plus it reduces sebum or oil production”. It can also improve your skin barrier function by preventing water loss through the epidermis (the outer skin layer). “Given that many people with acne have dry skin underlying their overproduction of oil, this too is super helpful for acne.”

Soap-free cleansers
“A lot of people think they need to use harsh products on blemish-prone skin,” adds Dr Mansberg. “Acne skin is actually often super sensitive with an impaired skin barrier function, so I recommend a gentle skincare approach including a soap-free cleanser.” She also says to steer clear of alcohol-based toners or physical scrubs. “They dry out the skin, disrupt the pH and microbiome of the skin and cause more inflammation.”

Non-comedogenic SPF
"By using active ingredients, you increase the skin's sensitivity to the sun," medical and cosmetic doctor Dr Ewoma Ukeleghe cautions. "So it's really important that you counteract that by using sunscreen." Here, look for non-comedogenic formulas, and try her tip of using a mattifying formula designed for the face on the body "in those specific areas where you are getting acne". 

Body facials
Finally, know that some spas and clinics offer the equivalent of a facial for the body. The Murad Deep Cleanse Back Treatment (available at Hershesons, Berners Street) is an excellent option, involving a deep cleanse, pore-cleansing mask, extractions—if required—and a relaxing massage.

Ideal for those suffering with body blemishes, a body facial will not only improve the condition and appearance of the skin immediately, but a therapist should be able to advise on aftercare, including the best product routine for your personal needs.

How long body acne takes to clear
As for a timeline on how long it will take to see results, it could be as little as two weeks although more inflamed spots may need to be subjected to a stricter routine before they disappear. “It takes 28 days for the skin cells to turnover fully, but the glands are more permanent and deeper structures,” explains Mitchell. “However as long as the irritations of blocked pores, excessive rubbing or staying moist for too long is removed, they should settle down.” Hopefully armed with active products—and a new incentive to shower off post-sweat session—your body acne should disappear as quickly as it arrived.

Story also written by Becci Vallis

This piece originally appeared in Harper's Bazaar UK